Towards Excellence:Driving up Quality Across the East Midlands

Health and Social Care Conference

25 February 2010

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Main Themes

• Why has the NHS been so poor at engaging the third sector?

• What is changing?

• The quality and productivity challenge

‘Failure’ of Commissioning

NHS has ‘commissioned’ for two decades, but …

• Commissioners’ capability has been limited

• Few levers, not well used

• Inadequate regulatory regime – bail out of NHS providers

• Low investment in developing commissioners

• Highly variable & fragmented practice

• Lack of legitimacy (linked to ‘voice’ & patient /public engagement)

• Very limited range of providers

An unfair playing field

• Lack of awareness amongst commissioners of the Third Sector

• Inconsistency of procurement and regulatory practices

• Great variation in when/whether to use grants or contracts

• Burden of disproportionate procurement practices – pre-qualification requirements, guarantees/bonds

• Poor funding practice: lack of full cost recovery > ‘subsidy’

• Poor funding practice: short-termism = barrier to investment

• Burden of disproportionate monitoring

‘Working with the Third Sector’ National Audit Office June 2005

An unfair playing field

The Commissioning Framework for Health and Well-being

Assuring high quality providers for all services

Obstacle: Providers are sometimes unwilling or unable to provide new and innovative services

Solution:

• Commissioning focused on outcomes

• Wider range of providers

• Develop effective, strong partnerships with providers

• Transparent and fair procurement

• More innovative provision, tailored to the needs of individuals (engage providers in needs assessments)

• Intelligent decommissioning

Quality & Productivity Challenge

• The population has increased 24% over the 60 years of the NHS

• More people now over pension age than under 16

• By 2031 the 75+ population will double to 8.2 million

• Half of babies born today will live to be 100

• Men and women live 10 years longer than in 1948

• Time lived with a limiting illness or disability has increased by over two years in past decade

• Alzheimer’s and other forms of dementia will double in a generation

• Demographic change will cost the NHS £1.1–1.4 bn extra each year

Source: The Human Factor, NESTA, 2009

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£1.4 bn challenge

Flat cash scenario

The scale of the challenge

Growth in Allocations Trajectory of rising costs

Our Aim

• The aim of the Towards Excellence programme is to drive up the quality of healthcare across the East Midlands, and ensure we have the resources to meet the challenges of:

– Demographic change– Increasing costs of drugs and technology– Rising demand– Growing expectations

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National

Regional

County health system

OrganisationTeam / Individual

Co-Production

Subsidiarity

Clinical Leadership

System Alignment

Responding to the Challenge - levels of working

PCT / Provider

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12 National Priorities Confirmed

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Priority Lead Primary Care Contracting Dame Barbara Hakin Technology / Digital Vision Peter Spilsbury Procurement Phillipa SlingerSupporting staff productivity Lorraine Foley (NHSI) Back Office Efficiency Tony SpotswoodDrugs – Prescribing Peter RoweClinical Support Rationalisation Dr Ian Barnes Right Care- Decommissioning- Threshold, referral/conversion management- Patient decision support

Sir Muir Gray

Safe Care Maxine Power (DH) Pathway - Long Term Conditions – Overall Sir John Oldham (DH) Pathway - Acute - Urgent & Emergency Care Sir John Oldham (DH) Pathway - End of Life Sophia Christie (BENPCT)

East Midlands PrioritiesClinical Priorities

£189 – 321mPotential opportunity

Transformation of the Urgent Care System £45 - 85m1

Delivery of upper quartile performance in planned care £7 – 17m2

VTE prevention £3 - 6m3

Long term conditions management - best practice pathways £67 - 68m4

End of Life care – best practice £10 - 26m5

Large scale prevention programmes £25 - 62m6

Reduction in caesarean section rates £1 – 4m7

Reducing out-of-area placements for people with learning disabilities £1 - 21m8

Significant reduction in prescribing and drug procurement costs £31m9

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Initial Priorities: Falls and Dementia

Non-Clinical Priorities

£355 – 512mPotential opportunity

Workforce productivity £169 -176m1

Rationalise back-office functions and supply chain management £25m2

Major improvement in productivity of Pathology services £20 - 40m3

Introduce standard thresholds for surgery £6 - 69m4

Estates optimisation £72 – 112m5

Reduce Variation and Maximise Capacity £3 - 27m6

Reduce costs of primary care contracting (LES, DES) £34 - 37m7

Reduce costs of Continuing Care £27m8

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Quality Observatory

• East Midlands QO was launched on 1 December

• It will provide the main mechanism to measure and track quality improvements

• Access to the data on the website is currently restricted

• It will gradually be opened to all

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Our Next Steps

• Establish priority work streams, with high quality leadership

• Set up PMO

• Develop detailed plan for each initiative

• Develop county health system assurance plans

• Closer alignment with local government / social care

• Produce SHA Delivery Plan

• Widespread communication and engagement

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